Prophylactic cranial irradiation in non-small cell lung cancer patients: who might be the candidates?

Abstract

Objectives: Brain metastases (BMs) often advance the course of non-small cell lung cancer (NSCLC). We performed an observational study in order to investigate the possible correlation of selected clinical and epidemiological factors with BM appearance in patients suffering from different histological subtypes of NSCLC stage I-IV. Methods: The study included 161 consecutive patients with NSCLC. Analyzed data included patient-and tumor-related characteristics. Results: Thirty-nine patients (24.2%) presented BMs within 12 (0-36) weeks of diagnosis. BMs decreased the mean overall survival significantly (15.6 versus 50.7 weeks, P , 0.001), with hazard ratio (95% confidence interval) 3.60 (2.42-5.35). The age of the patients with BM was significantly lower than that of the patients without BM (60.8 ± 8.9 versus 66.5 ± 8.5, P , 0.001). Patients with BM had significantly higher pack-years consumption (75.9 ± 23.9 versus 58.9 ± 31.9, P = 0.003) and larger tumor size compared with patients without BM (size in mm: 55.1 ± 20.1 versus 45.9 ± 19.3, P = 0.012). The presence of BM was also correlated with the absence of lung (P , 0.001), bone (P = 0.005), and adrenal (P = 0.046) metastases. Conclusion: Younger NSCLC patients with high tobacco consumption, large tumor size, and absence of metastases in other organs (lung, bones, adrenal metastases) are at high risk of BM appearance during the course of NSCLC and are candidates for prophylactic cranial irradiation early in the course of the disease.

Predictive risk score for isolated brain metastasis in non-small cell lung cancer

“…Additionally, we found a decrease in occurrence of IBM with increasing age. Similarly, Dimitropoulos et al found the incidence of brain metastases was reduced with increasing age ( 20 ). It is unclear why younger age is associated with higher brain metastases risk, it has been suggested that it may be due to cerebrovascular microenvironments, differences in expression of biomarkers, or better performance statuses and associated longer survival in young patients ( 9 ).…”

“…We found age less than 60 years had increased occurrence of IBM. Multiple studies also found patient age of younger than 60–70 years was associated with risk of brain metastases ( 3 , 9 , 17 , 20 ). Additionally, we found a decrease in occurrence of IBM with increasing age.…”

“…Similarly, our study found a strong association with histology type and IBM with adenocarcinoma being the most prominent and squamous cell having a lower associated risk. However, some studies found no correlation between histology and brain metastases ( 3 , 20 ). This discrepancy is likely attributed to the method of brain metastases assessment and diagnosis.…”

Osimertinib early dose reduction as a risk to brain metastasis control in EGFR‐mutant non‐small cell lung cancer

“…In line with our results and despite differences in age definitions, several studies have revealed that younger age is a risk factor for BMs in patients with EGFR‐mutant NSCLC. 18 , 19 , 20 , 21 Biological factors may differ between younger and older patients, including high levels of Ki‐67 and elevated expression of vascular endothelial growth factor (VEGF). 4 , 22 Extensive BBB dysfunction associated with aging may also be a reason for the differences associated with BM risk during treatment.…”